Which metric of ambient ozone to predict daily mortality?

It is well known that ozone concentration is associated with daily cause specific mortality. But which ozone metric is the best predictor of the daily variability in mortality?We performed a time series analysis on daily deaths (all causes, respiratory and cardiovascular causes as well as death in elderly 65+) in Vienna for the years 1991–2009. We controlled for seasonal and long term trend, day of the week, temperature and humidity using the same basic model for all pollutant metrics. We found model fit was best for same day variability of ozone concentration (calculated as the difference between daily hourly maximum and minimum) and hourly maximum. Of these the variability displayed a more linear dose–response function. Maximum 8 h moving average and daily mean value performed not so well. Nitrogen dioxide (daily mean) in comparison performed better when previous day values were assessed. Same day ozone and previous day nitrogen dioxide effect estimates did not confound each other.Variability in daily ozone levels or peak ozone levels seem to be a better proxy of a complex reactive secondary pollutant mixture than daily average ozone levels in the Middle European setting. If this finding is confirmed this would have implications for the setting of legally binding limit values.

► We performed a time-series analysis over 19 years of ozone and daily mortality.
► Within-day variability of ozone was the best predictors of same day mortality.
► Previous day nitrogen dioxide did not confound the results.